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Time-out and removal of privileges are approaches that involve removing positive reinforcement for unacceptable behavior. For young children, time-out usually involves removing parental attention and praise (ignoring) or being placed in a chair for a specified time with no adult interaction. For older children and adolescents, this strategy usually involves removing privileges or denying participation in activities (eg, grounding for an evening with no TV or loss of driving privileges). To be effective, this strategy requires that a valued privilege or reinforcer is removed. In preschool children, time-out (removal of positive parental attention) has been shown to increase compliance with parental expectations from ~25% to 80%,12 and similar effectiveness is seen when used appropriately with older children.14 To be effective, however, time-out must be used consistently, for an appropriate duration, not excessively, and with strategies for managing escape behavior in place before the time-out is imposed. To be successful, time-out requires effort and practice on the part of the parents and, in some cases, requires specific education with a professional.

Several aspects of time-out must be considered to ensure effectiveness. When time-out is first implemented, it usually will result in increased negative behavior by the child, who will test the new limit with a display of emotional behavior, sometimes approaching a temper tantrum. The parent who accepts this normal reaction and does not respond to the child’s behavior will find that outbursts become less frequent and that the targeted undesirable behavior also diminishes or disappears. When time-out is used appropriately, the child’s feelings are neither persistent nor damaging to self-esteem, despite the intensity of the reaction. However, if the parent engages in verbal or physical interaction with the child during this disruptive behavior, the emotional outburst, as well as the behavior originally targeted, not only will persist, but may worsen. Second, time-out often is not effective immediately, although it is highly effective as a long-term strategy. Third, it is often difficult emotionally for a parent to ignore the child during periods of increased negative behaviors or when the child begins pleading and bargaining for time-out to end. The inability of parents to deal with their own distress during a time-out is one of the most common reasons for its failure.